Variabilidad en la práctica de la cirugía mamaria en mujeres participantes en el programa de cribado poblacional de cáncer de mama

Introduction

Currently, variability in surgical practice is a problem to be solved. The aim of this study is to describe the variability in the surgical treatment of breast cancer and to analyze the factors associated with it.

Factores predictivos de infección de herida en cirugía colorrectal. Estudio observacional multicéntrico de casos y controles

Introduction

The aim of this study is to evaluate the usefulness of Vicryl Plus^® suture in reducing the rate of postoperative wound infection in elective colorectal surgery.

Methods

A prospective case-control multicenter study with 480 patients undergoing elective colorectal surgery was performed between 2006 and 2007. Patients were divided in 2 groups of equal sample size: group 1, closure of the abdominal wall using Vicryl Plus^® and group 2 where PDS II^® was used. The study involved 5 hospitals in the Spanish State. Wound infection was classified into superficial and deep. All patients diagnosed of wound infection during the hospital stay and up to 30 days after discharge were studied. For the statistical analysis Chi-square test and Fisher exact were used for bivariate analysis and logistic regression model for multivariate analysis.

Results

Wound infection rates were significantly lower in group 1: 14.6 vs. 29.2. Multivariate analysis showed that risk of wound infection was higher in patients with cancer, lung disease, anemia, operative time greater than 2 h, lack of second dose intra-operative prophylactic antibiotic and laparotomy closure with PDS suture II^®.

Conclusions

The use of suture coated with triclosan can be an effective prophylactic tool in reducing wound infection rate in patients undergoing elective colorectal surgery.     

New surgical approach to palliate tricuspid atresia in infants

An experimental surgical technique is proposed to increase pulmonary blood flow in tricuspid atresia with normally related great arteries. The method consists of the creation of ventricular septal defect in the infundibular septum by means of a closed surgical procedure. The expected advantage would be the growth of the right ventricular cavity. This would permit performance of a Fontan's procedure later, using the right atrium and the right ventricle. Microscopic sections from the hearts of 4 infants showed no damage in the conduction system. When performed in the beating hearts of dogs, the feasibility of the procedure was tested repeatedly without production of rhythm disturbances.     

Impact of early elective tracheotomy in critically ill patients

IntroductionTracheotomy is one of the most frequent surgical procedures performed in critically ill patients hospitalized at intensive care units. The ideal timing for a tracheotomy is still controversial, despite decades of experience.ObjectiveTo determine the impact of performing early tracheotomies in critically ill patients on duration of mechanical ventilation, intensive care unit stay, overall hospital stay, morbidity, and mortality.MethodsRetrospective and observational study of cases subjected to elective tracheotomy at one of the intensive care units of this hospital during five consecutive years. The patients were stratified into two groups: early tracheotomy group (tracheotomy performed from day one up to and including day seven of mechanical ventilation) and late tracheotomy group (tracheotomy performed after day seven). The outcomes of the groups were compared.ResultsIn the early tracheotomy group, there was a statistically significant reduction in duration of mechanical ventilation (6 days vs. 19 days; p < 0.001), duration of intensive care unit stay (10 days vs. 28 days; p = 0.001), and incidence of ventilator-associated pneumonia (1 case vs. 44 cases; p = 0.001).ConclusionEarly tracheotomy has a significant positive impact on critically ill patients hospitalized at this intensive care unit. These results support the tendency to balance the risk-benefit analysis in favor of early tracheotomy.     

Aplasia cutis congenita

We report a family with aplasia cutis congenita, an extremely rare condition. Particular attention is paid to the clinical, etiologic, and genetic characteristics. The only possible treatment, as in the first case in this family, is excision and reconstruction by dermatologic surgery procedures.     

Utilidad de la resonancia magnética en la estadificación prequirúrgica del cáncer de endometrio

Objective

To evaluate the usefulness of magnetic resonance imaging (MRI) for preoperative staging of endometrial carcinoma.

Materials and methods

We performed a retrospective study of 71 endometrial neoplasms diagnosed in Hospital Sant Joan de Déu. The results of preoperative MRI scans were compared with those of the definitive histological examination.

Results

The preoperative stage obtained by MRI and the final stage were concordant in 69% of cases.

Conclusion

MRI is the most useful diagnostic method for preoperative staging of endometrial carcinoma     

Estudio observacional de seguridad,prospectivo y unicéntrico para determinar la capacidad alergogénica de Mercromina Film® y otros antisépticos de uso común en pacientes con dermatitis de contacto

Introduction

Although Mercromina Film and other topical antiseptics are widely used, they are not included in the standard series recommended by the Spanish Contact Dermatitis and Skin Allergy Research Group for testing suspected allergic contact dermatitis (ACD). Furthermore, no recent studies have investigated the allergenic potential of merbromin.

Recomendaciones del Grupo Español de Trabajo en Enfermedad de Crohn y Colitis Ulcerosa (GETECCU) sobre la utilidad de la determinación de calprotectina fecal en la enfermedad inflamatoria intestinal

The management of inflammatory bowel disease (IBD) is currently based on the objective evaluation of intestinal lesions. It would therefore be interesting to have access to simple and non-invasive tools to monitor IBD activity and to identify the presence of lesions. Faecal calprotectin (FC) is the main cytosolic protein of neutrophils, it is resistant to bacterial degradation and it is stable at room temperature for several days, characteristics that make it suitable for use in clinical practice. It can be used to differentiate between inflammatory and functional processes, it correlates with endoscopic activity, it is associated with clinical and endoscopic response to treatment and it has short-term prognostic value. This paper offers an up-to-date perspective on the information that FC can provide clinicians to aid diagnosis, monitoring and management of IBD.     

Infección de la localización quirúrgica. Profilaxis antimicrobiana en cirugía

Surgical site infections (SSI) are very common, and represent more than 20% of all hospital-acquired infections. SSIs are associated with a higher mortality, as well as to an extended hospital stay and costs, depending on the surgical procedure and type of SSI. Advances in control practices for these infections include improvement in operating room ventilation, sterilization methods, barriers, and surgical techniques, as well as in surgical antimicrobial prophylaxis. For the latter, the antimicrobial agent should: be active against the most common pathogens, be administered in an appropriate dosage and in a time frame to ensure serum and tissue concentrations over the period of potential contamination, be safe, and be administered over the shortest effective time period to minimize adverse events, development of resistances, and cost.     

Cirugía a corazón abierto para el tratamiento de trombo auricular derecho relacionado con cateterización venosa central

Central venous catheters are widely used in critically ill patients; however, they are also associated with increased morbidity and mortality. The literature may underestimate the incidence of catheter-inducible right atrial thrombi that are asymptomatic but potentially life threatening. The recognized risk factors for its development include infections related to the catheter, endothelial injury secondary to mechanical and chemical damage induced by certain medications and infused fluids. The characteristics of the patient and the catheter, such as size, material, type, location and ease of insertion, as well as the duration of placement play an additional role.We report the case of a 38-year-old man, who developed an asymptomatic catheter-inducible right atrial thrombi requiring open heart surgery, after taking a central venous catheter for thirty-five days. The present case highlights existing limitations in making a correct and fast diagnosis, which should be anticipated in patients with multiple risk factors for thrombosis. Given the limited recommendations available, we consider that the most appropriate strategy should be individualized.